2. Description
   This form is for use by Kansas libraries for Gale web access authorization. After submitting this form, libraries can expect to receive their own Gale URL (web address) within 7 to 10 days. Instructions will be emailed to the recipient's email address(es) that you provide in the form below; instructions for using the Gale URL will be included. If you have questions about completing this form, they can be submitted via email.
4. Library*
5. Institution
7. Address*
9. City*
10. State*
11. Zip*
13. Library Contact*
15. Phone*
16. Fax
17. Email*
19. Technical Contact*
21. Phone*
22. Fax
23. Email*
27. Internet Access Information
    How do you connect to the internet? If you use modems, or share a network with a non-subscribing agency, indicate in (a) below. If you have exclusive use of a private network that connects to the Internet via a firewall or proxy, indicate on (b) the public IP address of your firewall or proxy. Otherwise, indicate on (c) the IP address (or range) corresponding to hosts on your IP network.
29. (a) Dialup IP Provider
31. (b) Private Network to Internet Gateway (list gateway IP)
33. (c) Direct Connection to Internet (list all IPs or IP range(s))
37. Comments / Special Instructions
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit

* indicates a required field